Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Wednesday, August 29, 2007

For those of you both in and out of medicine I have an honest question. Does your job make you miserable? I mean miserable to the point of sleep loss, depression, anxiety, sheer frustration, and surender?

I once again am faced with the following facts. After three overnight shifts, all of which dragged on two hours past the 7am quit time because of disposition dificulties. I then went home and tried to sleep but couldn't, my brain was on overdrive and the adrenaline was peaked and I was way past anger and just at sheer surrender.

Over the course of the last 5 days I have caught up on my sleep and got back on a day schedule. The night after my last overnight, at about 7pm, I hit the rack and DID sleep, for 17 hours straight. Then, over the last few days I have done some yardwork and spent time with family and friends.

Today, the fifth day after my most recent shift, I feel relaxed and at ease. College football starts tomorrow, God's in his heaven, and all's right with the world.

But on Saturday I go back in for four 6am shifts in a row. I know I'll be back at the dark place pretty soon, so, once again, I ask, is it like this for all of you too? Honestly, I'm not looking for sympathy and I'm not trying to be a tough-guy or anything, I'm just looking for some perspective. Thanks for your help.

34 comments:

I've been there, it's why I changed job locations. At the old place (12 hr shifts, single coverage with a couple of PA's) I'd get home nearly seethingly angry, and depressed I had to go back. I did that for six months, realized I was a statistic waiting to happen, and started looking for another job, one with shorter shifts and better doc coverage.

Now, I won the Lottery on ED jobs (best ever, for me), and your mileage may vary. My point is, if you sat and wrote down the significant stressors that you have, my bet is 75% of them are long-shift/short-staffed at the root, which drives up wait times, makes for pissy patients and shockingly unpleasant nurses, and the whole environment is self-sustaining.

Now, if your list says "I hate people, all people, and helping those who are actually ill means nothing to me", then maybe a change in careers is in order, but before you chuck a decade of hard-won knowledge and experience, try looking for a different environment first.

Been there, still somewhat there. Like GruntDoc I was doing 12 hour shifts, shitty nursing coverage, shitty staff response and shitty compensation. It got so bad that I quit my last job even before I had another one . I just knew I couldn't do that for one more day. Found another job with better hours, better coverage, and better pay. I still get depressed when a string of shifts like the one I am on now comes up, 5 in a row through the weekend, and on nights 'cause I have trouble sleeping during the day. There are better opportunities out there.Until then let the bullshit wait, take care of the sick, and especially take care of yourself. The team needs you.

I've been enjoying the Blog for quite some time after my wife showed it to me a while back. Let me offer a little bit insight.

In my world (independent safety consulting) it is pretty well known that rotating shift work sucks, regardless of how many days you get off between shifts. People get cranky, stay cranky and never get enough rest either quality or quantity. Worse, they just never get used to it. While I have not yet seen peer-reviewed data on this, it's evident in every place that I've been in that has multiple ROTATING shifts.

On the other hand, places that have fixed shifts, people get used to it and are more adjusted to the schedule.

So your frustration, crankiness, depression, anxiety and all of the other things you're feeling is "normal" for folks that work rotating shifts.

The question then becomes what are you going to do about it? You have choices, but you may be in a position right now where you don't like any of the choices you have - the idea then becomes how you place yourself in a position to have better choices. You're a blessed individual - talented, intelligent. Where can you best apply those talents and keep your sanity?

There is absolutely no need for you to ever say, "I can't get enough Prozac to make my life worthwhile."

If if sucks that bad and it's affecting your health and the health of your loved ones - time to move on.

Sleep disturbance plays hell with your mood, and there's no way to compensate if your shifts are constantly changing. If you weren't springing back after 5 days off, that might be time to worry about a more permanent burnout/depression problem.

College football starts tomorrow, God's in his heaven, and all's right with the world.

Amen.

Anyway, I know I only count a little, but I would offer the advice that I know a ER Doc that is so much like you that he could in fact possibly be you, and he carries much of the load and stress on his shifts because he is the only doc on lots of times that the nurses trust.

If you are working with no decent support system and holding up the whole ER on your massively muscled manly shoulders, and the higher ups have their heads up their asses and the lower downs are retarded half the time, then perhaps you need to find a job that isn't sucking the life out of you. Maybe you could go to nursing school. ;-)

PS: If your nurses love you nearly as much as we love our doc who is like you, there will be much wailing and gnashing of teeth if you were to leave. There may even be a revolt. You could be the next Che Guevara. How do you feel about Marxism?

Sounds rough. I'd echo GD's comments. No, it's not that way for everybody or all the time. I've seen a lot of places and a lot of docs come and go. Sometimes it's the facility (staffing, intensity, shift lengths, etc), sometimes it's the doc (some are just not cut out for this gig), most of the time it's just a tough month (or year). Usually the latter.

But seriously, take a hard look at your facility -- if it's the problem, think about changing jobs (c. ref. GruntDoc). There's no rule that you need to stay at the same place forever, and a well-considered change of venue can make a world of difference. OTOH, don't be shy about taking a hard look at yourself. Two of the best ER docs I have ever worked with left our group and the practice of EM because they realized that it just didn't fit their personalities. They both are now working at local walk-in clinics and are way happier. Not an easy change to make -- one likened it to the trauma of a divorce -- but it paid dividends for them in terms of their ability to enjoy life.

Hi. I work in IT and am posting this at 5AM after working 15 straight hours yesterday, going back in at 2AM and taking a quick break before I go in for my regular shift at 8AM today. I have hit the place you describe on weeks where I have worked up to 35 hours of overtime. I still love my job, but on those weeks, I just don't want anyone to bother me ever again. I've discovered as long as it's an occasional schedule, not an everyday one, I can still maintain a healthy balance between work and life. That balance is what constitutes my continued enjoyment of my job and the happiness of my family.

Chronic sleep deprivation will definitely affect your mood and your outlook, that's why you feel so much better after being off for a few days. It helped me to change to an exclusively night schedule, but it's not for everyone.

Even a couple of hours less sleep each day (over the course of a few days in a row) catches up to me and drags me down, so I try not to work more than 4 shifts in a row for that reason. I'm not sure at this point if it would be any better for me if I worked only days or rotated shifts, because I've gotten to where I usually can't ever sleep at night for more than a couple of hours. And even on my off days it's always a challenge to stay awake in the afternoon, even if I have managed to sleep that night or morning.

I still love my job though. I've worked at five different facilities over the years, and they have been significantly different in the types of patients, stressors, and responsibilities. A couple of them I really wouldn't want to go back to.

Um. Not a doctor, but if you work 3 and have 5 off, that's about as good as it will get as far as rest goes in any career in any field. We have a few MDs who do the 3 12-hours in a row and 4 off thing and 100% of them look like sh*t halfway through the 3rd one.

As far as disposition problems go, is there a problem with your daytime docs refusing sign-outs or something weird like that? I've never seen a doctor stay that late. That's something that your facility could improve...

I work A LOT, and get a little bitchy on my 9th (8 hour) shift in a row out of 9 or whatever, but I think the fact that we're not seriously understaffed, not holding inpatients (our hospitals big-wigs speak at conferences and things about patient flow), and all that makes a big difference.

Since I don't actually work outside the home, my opinion on this is useless (but I wanted to comment anyway!) I feel like part of the problem is your lack of sleep or at least lack of good sleep. I know with me when I get decent sleep, nothing seems to bother me nearly as much.

You said you didn't want sympathy, but regardless of whether you want it or not, you have mine.

And if you check out my post today, you'll see why I am ending this with "hi kettle, I am black" because I can't seem to get the sleep thing right for myself either.

I try to avoid signouts, for many reasons, and it's not unusual for me to stay a couple of extra hours on an overnight (long) shift. An hour is more typical. It's hard to get patients admitted right at 7:00. Most of the admitting docs don't call back until 7:30 or 7:45, then you might have a CT scan or two you are waiting on.

Most of us don't like to dump a handful of unfinished work on our colleagues.

i appreciate all the comments (even the one from my 'friend' DrX). thanks monkey girl (glad i come across as semi-competent), rad girl, shadowfax, grunt doc, scalpel, 'cat, and all of you.

let me expand a little bit. i worked in 7 different hospitals in residency and have worked in three since residency. i am no longer hopefull that there is a job out there in emergency medicine that will make all of this 'okay'.

as i've said before, i am actively seeking other options. updates to follow.

i think, after much reflection, that i could do this well as a young, single guy, but being neither young nor single i may be working on borrowed time.

like the squirrel before the first frost i'm packing it away. then i plan to take my ball and go play with some other folks, even if they pick me last.

I'm an electrical engineer who works in the aerospace. I've been on fatality accident boards, cause resolution, and solutions. I've had all the above anxiety and stress symptoms. I handled it for a while, then my boss left after 3 years and the new boss was a female Nazi youth member who just received her first chance at management. I quit. I now have a very low stress boring job completing aviation development plans and procedures.

I think the solution is work variety. No one should eat the same thing everyday. Variety is needed. I do contract engineering now, a completely different job every 1 to 2 years.

Take a low stress job vacation, and then go back to emergency work if you still want to!

If you truly get sick of it all, your family can come live with us. We have a great swingset in the backyard, I bake all the time...really what more can you ask for? Communes are cool or something (imagine that in a Beavis voice though).

Psst. 911. Come to my state, home of the best hospitals in the US. We'll have ya.

Some of our doctors do 50% ER and 50% "other" like occ health clinic work, vein stripping, back pain management with steroid injections and other such miscellaneous low-stress stuff (or so they call it low-stress). Maybe you could consider something like that?

Most of our Docs do 3 12's a week. 2 on 1 off 1 on 3 off. There's ample opportunity to pick up extras if you like but, very few do it. We also have a minimum of 2 docs on at any time, 3 if you count the doc covering our "urgent care" which is open from 1100-2200.

I'd gladly trade you for the humorless goat we currently have to put up with.

I've had jobs where I've found myself waking up next to a loaded 12 bore and being disappointed that it didn't discharge. Work is work, and it pays the bills and isn't gonna be fun all the time. But if it's getting soul-destroying, get help and a new job.

911..As probably the oldest on the blog, "I feel you, Man"...All of you will say I'm lying, but due to circumstances that 911 knows of, I now work out of the state in which I live. And I work 12-14 shifts in a row, 9hrs.. and rotate thru all the hour slots while I do that. My current job is the best I've ever been in as far as group dynamics and that is why I am able to do it that way. It's "eat what you kill"..If you don't see pts you don't get paid..No hourly, etc..Do I still feel the way you do.YES. It is because we have allowed Hospitals to control the way we practice via "pt satisfaction scores" What a crock of Dung!! I can no longer tell a POS to get the hell out of my ER! My nurses are great, my colleagues are fantastic, that's the only way I survive.Now I've decided to switch gears and am going back into academics. If successful, I'll be the only ED doc who's ever started TWO EM residencies up from scratch! In a nice big old COUNTY hospital where they don't even bill 50% of the pts. and don't really give a crock about pt satisfaction scores, just outcomes!Knowing you, You should look for an academic position. You are bright, energetic and would be an excellent teacher.Don't give up the ship! I sometimes still have fun practicing, too...

i appreciate that you think i would be a good academician. one problem, i have absolutely no interest in research and academics is all about research and bringing in grant money. not to worry, got plans in the works that should greatly improve my situation. updates to follow.

as you may know my previous job was with a group of back-stabbers in a great hospital with all manner of super-specialists. my current situation is with a great group of docs in a hospital that, well, needs to improve A LOT. after five years here i have seen things get worse and not better so i don't hold out much hope.

i am also wedded to this community for reasons outside medicine so there's the rub.

now, oldfart, 'cat, and etotheipi, how about a new post guys. especially you, etotheipi, how about a good gross-out path story to get the discussion back to our normal low level of bathroom humor?

Little late to the game on this one but what the hell - you're looking for pennies and I have a couple of shiny ones left over from grocery shopping. :)

As a resident, I'm in a different place every month. In the second year, however, we do two months of outpatient back-to-back. Every resident that's gone through my program has become depressed/homicidal/alcoholic after those two months - the monotony of the patients and the broken system that never gets fixed is enough to drive any sane pediatrician to drink.

I also find happening to me what you're going through when I get to the end of some months - that I've had enough and I just can't take it anymore. When I came off night float recently I was a raving lunatic. I'm in the ER right now (yay - definitely one of my favorite rotations) and I can tell you that I will be very catty at the end of this month.

I'm hoping that as a hospitalist my schedule will vary enough and that I'll be wearing enough different hats that I won't have a period of time where I'm Queen Bitch. And if I get that way, I'll know it's time to move on to something else.

I really don't have any advice for you - sorry. But I sure as hell sympathize.

I've thought about this for years, but I don't think I've ever voiced it to you. The decline of our individual career endeavors seem to be happening in unison. In your case I blame it on Insurance Companies (and their actuarials) and well paid administrators more concerned with perceived "efficiency" than what will happen to a hand full of REAL PEOPLE that particular day.

In my case I blame lawyers who pass themselves off as CEOs, and are also more concerned about the perception of efficiency over the people they serve.

Being in the airline business for these past 8 years, I have seen a 40% reduction in pay as they lower the threshold of entrance qualification while raising the number of aircraft in the air. In the meantime we are seeing unprecedented salaries being paid to CEOs for their cunning in turning the tragedy of 9/11 into the perfect excuse to gut their employees contracts and steal their pensions. Like you, I spent years paying dues to get where I was only to see others line their pockets by my efforts.

My brother is the Vice President of a Bank that was just bought out by a larger bank. He, as you and I, worked for years in the trenches to obtain this position. After the acquisition he was offered the opportunity to interview for his own job. This larger bank that bought his out has a reputation of taking jobs like his and offering them to senior tellers at considerbly lower salaries. If there is a question they can't answer, they point the customer to a website or a 1-800 number serviced by someone in India.

My bottom line is that I'm filling my war chest (sort of literally right now) and starting my own business. It is the only way I have any control over my destiny, and once there I intend to cut all ties to my previous employer.

Bottom line...I paid early to be able to sustain a particular quality of life. If they fail to provide that quality, I shall divest from them the assets I bring to the table. No one rules my destiny but me, and although you have responsibilities I do not...I am confident that no one will rule you for long either. I can't wait to hear your plans.

By this, I DONT mean: "suck it up and keep doing a job that makes you miserable". What I DO mean is: "suck it up and do something that makes you happy". My career change was the best thing I ever did - don't get tied down by money or some abstract notion of what you "should" do. Admit you are on the wrong track and make it right. THAT takes guts.

Hey the - am relatively new to ED work - only racked up 4 months experience so far, but I feel absolutely blitzed. Have made more fuck ups in te last 3 months, than i did in the enirety of my other intern work. Have just fininished 7 nights (10 hrs rosterd) then two off, then 6 afternoon shits with 3 days off, and then back into 7 nights. Thought I;d be up for it, but it just seems to be adding. Plus thre stress of not really knowing what to do all the time, and having to govel to seniors to review my patient/ provide advice is doing my head in. Does it get better - I really like the job, but the uncertainity, shitty patients and staff are really beginning to make me wonder. Any advice? Don't actively hate my patients, which is a good sign, but there are a few - got called to see a lady who had taken 2 x 2 mg tab of Diaz (no suicidl intent), and then came in coz she ws sleepy - how do you deal with that? she got an ECG/FBC and chem out of me plus some observtation time. WTF?

anonymous, welcome to the ER. the lady with the valium "OD" should have had her vital signs scanned, an EKG, ASA and APAP level and then let her sleep while you care for the sick. when you get a minute. discharge her with a family member. WTF indeed. she's about 40% of your patient population. careful, the sick ones are in there too.

I'm happy to say that I still don’t know what I want to be when I grow up. I was med school bound but after working with docs at the hospital I realized they were not happy. The initial reasons they had gotten into medicine, no matter how different they were definitely did not include being a stressed out businessman. I am still a huge medicine geek and have worked many different jobs in my 11 years of healthcare.

Before I take off further about my history the point of my post is to encourage everyone to set goals, shoot for them but do not be afraid to change. A career is a job you have been doing for too long. I understand that committing so much of your life to one goal makes any change hard to swallow but there is still allot of flexibility in your life. You change as you grow and so should your job. We need stimulation not torture.